No `Right' to Health Care

By
Stephen M. Bloch. Dr. Stephen M. Bloch, a fellow at Massachusetts General Hospital, is a principal in a health-care consulting firm based in Cambridge, Mass. /
June 28, 1993

THE language of rights and entitlements in the health-care debate is threatening to make a bad situation worse. By phrasing the debate in terms of a "right" to health care, the Clinton administration has already set up itself and the American people to lose.

"Rights" are absolutes which cannot be tampered with or negotiated. As long as people believe that their "right" to care is at stake, compromise and cost containment will be impossible.

Health care should be discussed the same way we discuss other vital consumer goods - food, for example. People should, to the extent possible, pay the true cost of their medical care, just as they pay their food bills.

Individuals must choose what level of health care they want and what they will give up to improve their care. No one should be financially crippled by a catastrophe or denied care because of poverty. Yet, unless forced individually to confront health-care costs, Americans will not be able to make rational decisions about the amount and type of care for which they are willing to pay.

As in the case of food, there should be a form of medical welfare to provide a safety net. And there should be a form of catastrophe insurance for problems that cost a family more than $10,000 or $20,000.

Everyone else - the bulk of Americans who receive health benefits through their jobs or otherwise - should be on their own. That means no more tax breaks for employer-provided health insurance. The consequences of this would be twofold. First, many individuals' health-care bills would temporarily rise. The bulk of Americans have employer-provided health insurance (really a form of tax-subsidized employee benefit) that provides filet mignon coverage to the individual while hiding the true cost. Not surpri singly, many Americans overeat.

Soon after, the national health bill would drop dramatically. A Rand Corporation study undertaken in the late 1970s supports this. The study found that if families were required to absorb the first $1,000 a year of their medical costs, they would spend 40 percent less on medical care than those with no insurance deductible, and with "negligible" effects on health.

MANAGED care - negotiating big packages through big providers - is a step forward. But managed care still keeps decisions too far away from the individual consumer. The only way to drive down health-care costs is for consumers to feel the costs and choose with their wallets.

Nor is the health-care world too complicated. Look at the mutual-fund industry. Twenty years ago, people kept their money in passbook accounts. Listen to people discussing their 401-K accounts in the mail room, and you'll see how much people can learn when there's an incentive to do so.

The Clinton administration is proposing a basic package of health coverage that fulfills every American's "right" to health care. The analogy to food is again instructive. Government experts advocate a recommended daily allowance of vitamins and minerals for each American. Yet we are not told exactly where to buy food and what to eat.

Whether it be in the case of food or health care, if the government separates "rights" from responsibility, people will have no incentive to curb their demands. Nearly 30 years of explosive costs and frustrating levels of service with Medicare and Medicaid bear this out.